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ofloxacin

Sold as Ocuflox. Class: Fluoroquinolones; Fluoroquinolones; Antiinfectives. First FDA approval 12/28/1990: 36 years on the US market.

This grade answers one narrow question: how strong is the public evidence and safety record behind this drug, and how clean is its money trail and court record? It is not a verdict on whether the drug is right for you.

B

Score breakdown (83/100)

Safety ×35%
A
Evidence ×25%
F
Regulatory ×15%
A
Money & lawsuits ×15%
A
Options ×10%
A

Safety: 95

Evidence: 41

Regulatory history: 99

Money & lawsuits: 100

Options: 100

Independent reviews and post-approval warnings

WHO Essential Medicine

Listed on the WHO Model List of Essential Medicines (antibiotic stewardship group: KeyAccessGroup, WatchGroup): a global expert panel judged it among the medicines a health system should always have, on evidence of value, not marketing.

What the FDA label says

Approved uses

INDICATIONS AND USAGE Ofloxacin ophthalmic solution is indicated for the treatment of infections caused by susceptible strains of the following bacteria in the conditions listed below:

Contraindications

CONTRAINDICATIONS Ofloxacin ophthalmic solution is contraindicated in patients with a history of hypersensitivity to ofloxacin, to other quinolones, or to any of the components in this medication (see WARNINGS ).

Warnings and precautions

WARNINGS NOT FOR INJECTION. Ofloxacin ophthalmic solution should not be injected subconjunctivally, nor should it be introduced directly into the anterior chamber of the eye. There are rare reports of anaphylactic reaction/shock and fatal hypersensitivity reactions in patients receiving systemic quinolones, some following the first dose, including ofloxacin. Some reactions were accompanied by cardiovascular collapse, loss of consciousness, angioedema (including laryngeal, pharyngeal or facial edema), airway obstruction, dyspnea, urticaria, and itching. A rare occurrence of Stevens-Johnson syndrome, which progressed to toxic epidermal necrolysis, has been reported in a patient who was receiving topical ophthalmic ofloxacin. If an allergic reaction to ofloxacin occurs, discontinue the drug. Serious acute hypersensitivity reactions may require immediate emergency treatment. Oxygen and airway management, including intubation should be administered as clinically indicated.

Adverse reactions (label)

ADVERSE REACTIONS Ophthalmic use: The most frequently reported drug-related adverse reaction was transient ocular burning or discomfort. Other reported reactions include stinging, redness, itching, chemical conjunctivitis/keratitis, ocular/periocular/facial edema, foreign body sensation, photophobia, blurred vision, tearing, dryness, and eye pain. Rare reports of dizziness and nausea have been received. Refer to WARNINGS for additional adverse reactions. To report SUSPECTED ADVERSE REACTIONS, contact Sentlss at 1--855-473-6847 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

Source: FDA SPL label for Ofloxacin (ARMAS PHARMACEUTICALS INC.), effective 20231023. Full label on DailyMed.

Side-effect reports sent to the FDA

These are counts of reports people filed, not rates of harm. Anyone can file one, and nobody checks whether the drug was the cause. Millions of doses are taken for every report sent, so the useful part is how this drug compares with the average across all drugs.

7,641reports that mention this drug
7,617of those blame this drug, not another one the person was taking
77%of reports describe a serious outcome, such as a hospital stay (average for all drugs: 57%)
7.9%of reports include a death, from any cause (average for all drugs: 9.1%)

Problems reported most often

Acute Kidney Injury · 408Eye Pain · 356Off Label Use · 355Drug Ineffective · 350Headache · 288Fatigue · 281Pain · 264Nausea · 261Arthralgia · 256Diarrhoea · 255Chronic Kidney Disease · 207Anxiety · 205Renal Failure · 203Condition Aggravated · 193Pyrexia · 189

Reports per year

20192020202120222023202420252026
924759698641695519525185

828 reports blaming this drug for every million Medicare prescriptions filled, which is 0.3× the typical drug on this site. (1,221 reports in 2024–2026, against 1,475,339 Medicare fills in one year. This is the one number here that accounts for how many people take the drug.)

Source: the FDA's Adverse Event Reporting System (FAERS). Reports are voluntary and unverified. Drugs that are prescribed a lot, in the news, or in lawsuits attract more reports, so the percentages are compared with the whole database to correct for that partly, not fully.

Recalls and regulatory record

1recall actions on file
4 / 29brand / generic applications
0label changes since 2021
NoREMS program
DateClassFirmReason
07/2019Class IIAltaire Pharmaceuticals, Inc.Lack of Assurance of Sterility

Class I = reasonable probability of serious harm. Class II = temporary or reversible harm. Class III = unlikely to harm. Most generic recalls are manufacturing or labeling defects for one lot, not a verdict on the molecule.

Evidence base

294randomized trials (PubMed)
2systematic reviews
472registered trials
27%of completed trials posted results
10%terminated or withdrawn
30%industry-funded

Counts measure how much evidence exists and how transparent it is, not how big the benefit is. For that, ask your prescriber: if 100 people like me took this, how many would get better because of it, and how many would be harmed? (Doctors call these the "number needed to treat" and "number needed to harm.") It differs by condition and is the number drug ads leave out. Sources: PubMed, ClinicalTrials.gov.

Money and lawsuits

In 2024, drug companies reported $0 in payments to US physicians and hospitals tied to this drug across 0 transactions.

No pending federal MDL names this drug or its brands.

Not named in any federal pharmaceutical settlement of $100M or more on record.

Sources: CMS Open Payments (Sunshine Act); Judicial Panel on Multidistrict Litigation pending docket list; DOJ settlements as tabulated on Wikipedia with links to the primary record. State-court and individual suits are not included.

Who takes it and what it costs

1,096,563Medicare Part D patients (2024)
1,475,339prescriptions filled
$19average cost per fill
$27Mtotal Medicare spend
ProductFills$/fill
Ofloxacin1,475,266$19
Ocuflox73$91

Same-class alternatives

acetic acidaluminum acetotartratebesifloxacinboric acidchloramphenicolclioquinoldelafloxacinenoxacinfleroxacinfosfomycingatifloxacingemifloxacingrepafloxacinhydrogen peroxidelomefloxacinmiconazoleneomycinnitrofurazonenorfloxacinpefloxacinpolymyxin brifamycin svsparfloxacintemafloxacintetracyclinetrovafloxacin

Same ATC pharmacological class, graded ones first, best grade at the top. Being in the same class does not make them interchangeable for your condition; it makes them worth asking about.

Questions to ask your prescriber

  1. The most-reported problems in FDA's adverse event data are acute kidney injury, eye pain. How would we recognize and handle those?
  2. Off-label use is among the most-reported items for this drug. Is my use on-label, and if not, what evidence supports it?
  3. Why this one over acetic acid, aluminum acetotartrate, besifloxacin? What would make you pick one of those instead?
  4. What result are we expecting, by when, and what is the plan if it does not happen?
  5. If 100 people like me took this drug, how many would actually get better because of it, and how many would be harmed by it? (Doctors call these the number needed to treat and the number needed to harm.)